Backfire: Chantix bad might outweigh good

Backfire! Have you ever done something for the “good of humanity,” only to have it backfire? A would-be mother-in-law thinks she's helping with the wedding, but ends up making the future bride scream. A friend gives unsolicited advice and ends up not getting invited to the next party. A politician thinks spreading the seeds of his loin will improve the gene pool, but then he gets dumped by his wife and politically assassinated by his colleagues– wait, that isn’t a backfire. That’s just stupidity and arrogance.

What happens when a smoking cessation drug might cause more heart attacks?

Chantix, Chantix, Chantix! When I wrote about Chantix in August 2006, I expressed some skepticism about the worthiness of the drug. Since then, Chantix has acquired a “Black Box Warning” that side effects might include depression. (I've seen this in my practice.)

And now, a 52-week study shows it might actually increase the risk of cardiovascular events (i.e. heart attack, angina).

First of all, why do healthcare providers want people with coronary heard disease (CHD) to quit smoking? Well, for starters, smokers with CHD and cardiovascular disease—atherosclerosis (clogged arteries), poor circulation, strokes– have an increased risk of a heart attack: six times higher in women and three times higher than in men who don't smoke.

That’s a lot! Smokers who have CHD have increased risk of heart attack and death, especially after undergoing bypass surgery or balloon angioplasty with/without a stent.

There are 1.3 billion smokers in the world who account for 36 percent of all first heart attacks. In America, 22 percent of men and 17.5 percent of women currently smoke, but 60 percent of smokers don’t believe the tobacco increases their risk of heart attack. Despite all the research, some folks still light up without the light bulb going on.

For folks who do want to, quitting can be as challenging as climbing Mt. Everest. So some smokers try to use medicines to help them quit. In this recent Chantix study, after four weeks of treatment, 47 percent of Chantix users weren’t smoking vs. 14 percent of folks using a placebo (a sugar pill). Nine to 52 weeks later, the rate dropped to 19 percent among Chantix users vs. 7 percent in the placebo group. Chantix or placebo was given to the patients for a total of 12 weeks, though smoking cessation counseling continued the entire year.

So you'd think the Chantix folks should have had fewer heart problems since more of them quit smoking than the placebo folks, right? Nuh-uh.

Non-fatal heart attacks, heart intervention for blocked coronary arteries, and peripheral vascular disease diagnosis or intervention occurred more in the Chantix group than in the placebo group. You'd also think hospital admissions for angina would be lower in the Chantix group than the placebo group, but that wasn’t the case either.

This study doesn’t confirm that Chantix increases the risk of cardiovascular events in folks with CHD. However, it does pose a serious question about the drug's safety. I don’t think it takes a rocket scientist to see the writing on the wall.

Let me say this: if the manufacturer saw fewer heart and cardiovascular problems in the Chantix group, the “good news” would be everywhere.

Quitting smoking can be achieved by some people through other modalities such as hypnotism, acupuncture, behavioral psychology, and/or coaching from healthcare professionals. Going cold turkey works for maybe one to three percent of smokers every year. I remind my patients that if at first you don’t succeed, try, try again. This plan rarely backfires on anyone.
Dr. Hook cracks a joke or two, but he's a respected physician with an interesting website,


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